Bike Fit & Injury
Bicycling is a repetitive stress type of activity and if your technique or fit is wrong, it is bound to lead to injury. When being fit to a bicycle, there are many areas that can be changed to accommodate the respective rider. This can be viewed from a performance (positioned for aerodynamics, etc.) as well as an injury (knee pain, back pain, etc.) prevention stand point. In many instances, there are very minimal changes that can be made to your fit which can go a long way in keeping you pain free. Most of these changes revolve around the position of your seat and involve moving it as little as 1/4 inch in a particular direction.
What improper fit is causing that pain?
Before changing the fit of your bicycle, keep before and after measurements (seat height, seat position, etc.). If the new change does not help, it will be easy to go back to the old measurements/fit. If you are not sure how to adjust any aspect of your bicycle, check with your local bicycle shop!
1: Upper Back/Shoulder pain-This is commonly due to having to reach too far from you seat to your handle bars. To help reduce the pain, simply try sliding the seat forward on its rails. Sometimes just as a little as a 1/4 inch increment is all that is needed. If the seat is already forward, as far as it will go, you may need to talk to your local bike shop about having a shorter stem installed. With a shorter stem, it will bring the handle bars even closer to you so you won’t have to reach as far.
2: Pain in the front of the knee-This is usually caused by your seat being too low. If your seat is too low when you are peddling, the knee that is on the up stroke (the knee that is highest when pedaling) must bend further than needed to accommodate the motion. Since the knee is bending further than needed, a greater amount of stress is placed across the front of the knee, as well as, structures such as the Quadriceps muscles as well as your Patella Tendon. By raising you seat slightly, the knee will not have to bend as far, taking some stress off it.
3: Pain in the back of the knee-This is typically caused by your seat being too high. When you peddle, the leg and knee at the bottom of your peddle stroke have to extend. If the seat is too high, then the knee extends too much in an effort for the leg to reach the peddle, causing structures along the back of the knee to get stressed. This includes structures like hamstrings tendons, Popliteus muscle, as well as the Gastrocnemius/calf muscle. Through lowering the seat slightly, the knee with not have to extend as much, which will help relieve stress from the back of it.
Injury of the month: Iliotibial Band (IT) Syndrome
What is it? Soreness and Tightness through the Iliotibial (IT) Band, which runs along the outside or your thigh. Imagine the IT Band as a thick rubber band that runs from your hip (Ilium bone) to just below the knee (Tibia bone). IT Band Syndrome can cause pain on the outside of your hip, thigh, or knee.
| Spotlight: Graston® Technique
Treatment of a calf strain with Graston® Technique. Graston® Technique is used in the treatment of soft tissue and repetitive stress/overuse injuries using stainless steel instruments. The instruments allow the practitioner to treat soft tissue with increased sensitivity then with hands and fingers. A wide variety of injuries can be treated including rotator cuff problems and hamstring muscle strains. Graston® Technique works to break down scar tissue and adhesions that develop in soft tissue from repetitive stress/overuse since the presence of the adhesions and scar tissue leads to pain and dysfunction. Relief is usually noticed after just a few sessions.
Lateral Epicondylitis being treated with Graston® Technique. |
How is it
injured? Repetitive Stress activities like bicycle ridding and running. IT Band Syndrome is not an injury that happens instantly. It becomes progressively tight over time but it can take a while before any pain or dysfunction is noticeable.
What causes it? As the IT Band is overused leading to injury, it becomes chronically tight. This could be the result of but not including improper biomechanics, weakness, or overcompensating. When the IT Band is overused, scar tissue is laid down to help it heal but unfortunately, the scar tissue can cause the IT Band to become tight which can lead to pain/dysfunction. 
Keep in mind that the IT Band takes much more effort to loosen than muscles like hamstrings. Because of this, it can take longer and more effort to stretch and loosen a tight IT band when compared to a hamstring muscle. In addition, you can usually feel when muscles are starting to tighten up-this is harder to notice with the IT Band.
Treatment of Iliotibial (IT) Band Syndrome with Graston® Technique.
How is it treated? Using deep tissue massage type techniques such as Active Release® (ART®) and Graston®, to loosen and lengthen the IT Band and break down scar tissue. In many cases, it is necessary to treat the hips as well as the lower leg since problems in these areas can cause improper biomechanics which can contribute to IT Band Syndrome. Since the IT Band is not much of a muscle, exercises are aimed at strengthening and balance of the whole lower leg targeting structures around the IT Band.
Stretch of the month: Single Leg Hamstring
What does it stretch? Hamstring muscles individually.
Why you should do it? The hamstrings are big and very influential on the body, since they run from your Ischium (butt) bone to just below your knee. Tight hamstrings can often be correlated with low back pain. If your hamstrings are tight, it can pull your pelvis out of alignment. Since your spine sits on top of your pelvis, this can throw off the balance of the curve of your low back. If this happens the muscles in the low back work harder then they need to in order to support the spine.
How should you stretch it? While sitting on a bench, drop your left leg off the bench keeping your right leg and knee straight. In this position, bend forward at your waist keeping your back straight reaching for your right foot with both hands. If you are unable to reach your foot, use a towel or rope as an extension of your arms. The stretch should feel tolerable, but not hurt. Hold the stretch (do not bounce) for 20 seconds and repeat 2 times at least 1 time per day. Once the right hamstring has been stretched, change the positions of the legs so the left hamstring can be stretched.
When not to do it? You are suffering from severe low back pain or you have recently pulled your hamstring. If you are experiencing tingling or numbness into the groin or legs check with your doctor first.
"Helping you reach the finish line pain free!"
If you have an injury, or a previous health condition, check with your doctor before performing any of the information mentioned in this article.
Dr. Bradley R. Schmidt, D.C.-As a three time Ironman Hawaii finisher, as well as, a college cross country runner, Dr. Schmidt has suffered his fair share of injuries. He enjoys sharing his first hand injury experiences from training and racing, incorporating them into the treatment of his patients. Dr. Schmidt also incorporates techniques such as Active Release®, Graston®, Active Isolated Stretching, and Kinesio® Taping. By combining athletic experiences and effective treatment techniques, Dr. Schmidt is able to understand and help athletes and patients reach the finish line pain free!
Questions? E-mail us at drschmidt@excelsporttherapy.com or visit www.excelsporttherapy.com
All information copyright Dr. Bradley R. Schmidt, D.C.